Page2 - Page 2 SMOKING HABITS Did subject ever use Tobacco Products YES NO IF YES then specify the Status and amount below Cigarette Status Current

Page2 - Page 2 SMOKING HABITS Did subject ever use Tobacco...

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SMOKING HABITS Did subject ever use Tobacco Products: YES / NO IF YES then specify the Status and amount below Cigarette : Status: Current/ Former/ Never Number: ___/ Day Cigar : Status: Current/ Former/ Never Number: ___/ Day Pipe : Status: Current/ Former/ Never Number: ___/ Day Other: ______ Status: Current/ Former Number: ___/ Day Did subject ever drink Alcoholic Beverages?
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  • Summer '16
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  • Alcoholic beverage

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